Download Bunion surgery V3 - The Dudley Group NHS Foundation Trust

Bunion surgery
Orthopaedic Department
Patient Information Leaflet
Introduction
Welcome to The Dudley Group NHS Foundation Trust. This leaflet
is to provide information for patients who are considering having
bunion surgery. It describes the procedure, and its benefits and
risks.
What is a bunion?
A bunion is a deformity of the big toe. The medical name of a
bunion is hallux valgus. In people who have a bunion, the big toe
tilts over towards the smaller toes and a bony lump appears on the
inside of the foot.
Sometimes a soft fluid swelling develops over the bony lump. The
bony lump is the end of the ‘knuckle bone’ of the big toe (the first
metatarsal bone), which becomes exposed as the toe tilts out of
place.
How is a bunion treated?
It can be treated in various ways such as:
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Painkillers and anti-inflammatory medications
Orthotics such as insoles, bunion pads and toe spacers
Wearing different footwear such as wider, deeper shoes and
avoiding slip-on shoes
Surgery
What are the benefits of surgery?
Surgery may be of benefit if:
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non-surgical treatment has failed or is not suitable
you are having symptoms from the shape of your foot such as
pain when wearing shoes
your surrounding toes are becoming deformed
Surgery may reduce your pain and prevent further deformities of
your foot.
Will the surgery work?
The results of the surgery will depend on how severe your bunion is,
but more importantly, how willing and able you are to rest after the
operation.
According to the British Orthopaedic Foot and Ankle Society
(BOFAS), 85 per cent of people are satisfied with the result of their
surgery.
However, after you have had surgery, there is no guarantee that
your foot will be perfectly straight or pain-free. Surgery may reduce
the flexibility of your big toe joint and you may experience stiffness
in the area where the bunion was. Your toe may also be shorter
than it was before you had surgery.
What does the surgery involve?
You will usually be given a general anaesthetic for the procedure
which means that you will not be awake. However, it can be
performed while you are awake. For this, you would be given a local
anaesthetic, either with or without sedation.
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Usually, you only need to be in hospital for the day. If you will need
to stay overnight, we will discuss this with you during your
pre-operative assessment.
The procedure involves realigning the joint into a better position.
During the operation, the surgeon removes the excess bone with a
saw, dividing and repositioning the bone, and realigning the
ligaments and tendons. The bone is fixed with two screws and one
staple. The screws and staple are usually not removed. The wounds
are closed with dissolving stitches.
You will usually have two scars, one on the inside of your big toe
and one on the outside.
What are the risks of surgery?
As with all surgery, this operation carries some risks and
complications. It is important that we tell you about these risks so
that you can make an informed decision about your proposed
surgery.
The risks of the surgery include:
Infection
There is always a risk that an infection will develop after an
operation. These are not usually serious and can be treated with
antibiotics.
Blood clots
A deep vein thrombosis (DVT) is a blood clot in a vein that usually
causes symptoms of red, painful and swollen legs. The risks of a
DVT are greater after any surgery. A DVT can move through the
bloodstream and travel to the lungs. This is known as a pulmonary
embolism (PE) and is a very serious condition which affects your
breathing.
To limit the risk of a DVT, if you are able to wear them, you will be
given some elasticated stockings that are specific to your calf and
thigh measurements. Nursing staff will advise you on how to use
and care for these. You will need to wear these until you are able to
move about normally. Most patients do not need to take medication
to thin their blood.
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Other risks of this operation
 It is normal to have swelling for six to 12 months after the
operation but this can last for even longer.
 Stiffness in the joints of your toes.
 A delay or failure of the bone to heal, or the bone heals in the
wrong position. This is very rare.
 Pain under the balls of your smaller toes (the medical name of
this is transfer metatarsalgia).
 Damage to the nerves in your foot.
 The bunion may come back. If this happens, you may be offered
more surgery.
 Complex regional pain syndrome which is a condition that
causes long term burning pain in one of the limbs.
It can take up to one year to get back to normal after the operation.
Your risk of developing problems is increased if you have other
medical conditions that prevent or slow down the healing process.
For example, you are more likely to get an infection or have
problems with wound healing if you have diabetes or problems with
your circulation.
If you are a smoker, this may slow down your healing process so
you may wish to consider stopping. If you would like to be referred
to one of our Smoking Cessation Team, please ask a member of
staff.
General anaesthetic
If you have a general anaesthetic, it can cause serious problems
such as an allergic reaction but these are very rare. If you have any
worries about this, you can discuss them at your meeting before
your operation (pre-operative assessment) or with the anaesthetist
before your operation.
Sedation
If you are going to have sedation, you will be given a separate
leaflet about the side effects of this at your pre-operative
assessment.
X-ray precautions:
The procedure uses X-rays and these use a small amount of
radiation.
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What happens before the operation?
You will be asked to come for a health assessment with a nurse,
usually about one or two weeks before your surgery. This will
determine whether there are any reasons why you should not have
surgery.
During this health assessment we will:
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Check your suitability for anaesthetic.
Give you information about the surgery and recovery process. It
is important that you know what to do to help your recovery.
Carry out investigations to ensure that you are fit and well to
have the surgery.
A range of investigations will be carried out such as:
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A blood test, if you take certain medications.
You may have an ECG – a heart trace test. This is nothing to be
alarmed about, just a routine test to check your heart.
Your blood pressure, pulse and weight will be recorded.
You will be screened for MRSA – a nasal and groin swab will be
taken to see if you have any evidence of infection.
A finger prick test to check your blood glucose levels.
We will give you instructions about when you need to stop eating
and drinking before your operation.
You will have the opportunity to ask any questions you may have.
At this assessment, please tell us if:
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You are diabetic
You have a cold, cough or any type of infection
You take any medications and what these are. You may need to
stop taking some of these for a short period of time before you
have the operation.
Female patients – as we use X-ray equipment during the operation,
we will ask you the start date of your last period during the
assessment. Please tell us if you are, or might be, pregnant. If
you are not sure, a pregnancy test will be offered.
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What if I become ill before my operation?
It is important that you tell us if you are not well enough to come in
for the operation. Please ring one of the following numbers:
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Ward B1 on 01384 456111 ext. 4690 or ext. 4691
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Day Case Unit on 01384 456111 ext. 3578
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Pre-assessment Unit on 01384 456111 ext. 1849
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Your consultant’s secretary – please ring the main
switchboard number on 01384 456111 and ask for your
consultant’s secretary.
Also, please ring us if you have any type of infection such as a
cough, cold, chest infection, skin problems such as a rash, cut or
skin infection. If you are not sure and want to ask about this, please
ring your consultant’s secretary for advice.
What do I need to bring for my operation?
Please bring a dressing gown, slippers and any medication you are
currently taking. If you will be staying overnight, please bring an
overnight bag with nightwear, toiletries etc.
Please do not wear or bring any jewellery. However, you can wear
your wedding ring.
Please do not wear any make up, nail varnish or gel nails on your
fingers or toes.
What happens when I come in for my
operation?
When you arrive, you will be taken to an admission area. Here you
will be seen by:
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a member of the surgical team
the anaesthetist, if you are having sedation or a general
anaesthetic
a member of the nursing staff
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You will be asked to undress and put on a theatre gown shortly
before your surgery. You will be taken to the operating theatre by a
member of the theatre team.
Unfortunately, you may sometimes have to wait for a number of
hours for your surgery. We do appreciate how difficult and
inconvenient this might be and we try to minimise delays for all
patients as much as possible.
What happens after surgery?
Your blood pressure and pulse will be monitored. During your
operation, local anaesthetic is injected around your foot to minimise
the pain after surgery. It is impossible to get rid of the pain
completely but we aim to minimise it as much as possible. You will
also be given tablet painkillers to take home which you should take
regularly (always read the label; do not exceed the recommended
dose).
Once you have had something to eat and drink, you will be allowed
to get up. You will be assessed by the physiotherapist to see if you
are safe to use crutches.
You will be issued with a surgical shoe that has a plastic sole and
Velcro fastening, as you will not be able to wear a shoe for some
time (usually at least six to 12 weeks). You are usually allowed to
put weight on your foot, if you can tolerate it, using crutches to help
you walk and putting weight through your heel.
It is essential that you keep your foot raised, so your ankle is above
your knee, for the majority of the time for the first week after
surgery.
Please leave the dressings applied in theatre on your wound until
you are seen in clinic about 14 days after your operation. If you
have any problems with your dressings, please contact the ward,
the day case unit or your consultant’s secretary, as follows:
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Ward B1 on 01384 456111 ext. 4690 or ext. 4691
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Day Case Unit on 01384 456111 ext. 3578
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Your consultant’s secretary – please ring the main
switchboard number on 01384 456111 and ask for your
consultant’s secretary.
Once we have checked that you have been to the toilet and are
comfortable, you will be able to go home.
What happens when I go home?
If you go home the same day as the operation, you will need to
have someone to care for you for at least the first 24 hours.
You must not drive yourself home. You will not be able to go home
on public transport on your own. Therefore, you will need to arrange
for someone to collect you and take you home.
The nurse who discharges you from hospital will give you a letter for
your GP, a sick note if you need it and any medication that has
been prescribed for you. We will give you instructions on caring for
your wound.
Please ask your surgeon for advice about driving before you go
home.
What happens when I get home?
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You must have a responsible adult to go home with you and look
after you for 24 hours, if you have had a general anaesthetic.
Do not operate machinery.
You must have access to a phone on the day of your surgery
once you return home, in case any problems occur.
Wound care
You will need to keep your wound clean and dry until you see your
consultant about 14 days after your operation.
Reducing swelling
Your foot will be swollen and so while you are recovering, you will
need to keep your foot raised, so your ankle is above your knee, to
reduce the swelling.
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Wearing shoes
It can take several weeks before you will be able to wear normal
footwear. We recommend that you wear flat or low-heeled, widefitting shoes. Shoes made from soft leather are ideal because they
will not put pressure on your foot.
When can I go back to work?
You will have to take some time off work. The exact amount of time
varies depending upon your occupation. However, it is likely that
you will need to take at least six weeks off. If you have a manual
job, it may be about 12 to 16 weeks before you can to return to
work. Please speak to your consultant about this.
What follow up care will I receive?
We will send you a follow up appointment so that we can inspect
your wound. This will be about 10 to 14 days after your operation.
Can I find out more?
You can find out more from the following web links:
NHS Choices
http://www.nhs.uk/Conditions/Bunion/Pages/Treatment.aspx
British Orthopaedic Foot and Ankle Society
http://www.bofas.org.uk/Patient-Information/Hallux-valgus-bunion
Reference
British Orthopaedic Foot and Ankle Society (Date unknown). Patient
information Hallux Valgus (bunion). Accessed June 2015. Available
at:
http://www.bofas.org.uk/Patient-Information/Hallux-valgus-bunion
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If you have any questions, or if there is anything you do not
understand about this leaflet, please contact one of the following:
Ward B1 on 01384 456111 ext. 4690 or ext. 4691
Day Case Unit on 01384 456111 ext. 3578
Pre-assessment Unit on 01384 456111 ext. 1849
Your consultant’s secretary – please ring the main switchboard
number on 01384 456111 and ask for your consultant’s
secretary.
This leaflet can be downloaded or printed from:
http://dudleygroup.nhs.uk/services-and-wards/trauma-andorthopaedics/
Originator: A Bolt. Date originated: June 2015. Review date: June 2018. Version: 3. DGH ref: DGH/PIL/0702
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